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Virtual Pediatric Hospital: Paediapaedia: Duodenal Atresia / Stenosis Paediapaedia: Gastrointestinal Diseases

Duodenal Atresia / Stenosis

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
The prenatal history is remarkable for a maternal ultrasound showing polyhydramnios and a "double bubble" sign due to fluid in the duodenal bulb and stomach. The post natal history is remarkable for bile stained vomiting, usually in the first day of life. The patients have minimal abdominal distension due to the high level of obstruction. Jaundice may be seen when the duodenal atresia is at the level of the ampulla of Vater.

Etiology/Pathophysiology:
The ratio of duodenal atresia to duodenal stenosis is 4:1. The point of atresia is distal to the ampulla of Vater in 75-80% of patients. Related anomalies include: Downs Syndrome in 30%, esophageal atreasia and tracheoesophageal fistula in 13%, multiple intestinal atresias in 15%, and annular pancreas in 21%.

Pathology:
Not applicable

Imaging Findings:
On an abdominal film, a gas distended stomach and duodenum gives the "double bubble" sign with no gas distal to the duodenum in duodenal atresia. Once duodenal obstruction is recognized further imaging is usually unnecessary as surgery is indicated emergently. If further imaging is required, air, non-ionic contrast or barium can be injected though a nasogastric tube to better outline the level of obstruction.

DDX:
High bowel obstruction

References:
See References Chapter.

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